방광의 원발성 소세포암 1례

성득제,이정구,조재흥 大韓泌尿器科學會 1994 Korean Journal of Urology Vol.35 No.10

신세포암에서 새로운 TNM병기분류법(TNM 97)에 따른 전산화단층촬영의 병기결정 : 이전 병기분류법과의 비교

성득제,김윤환,정환훈,정규병,서원혁 대한영상의학회 2001 대한영상의학회지 Vol.44 No.5

목적: 신세포암에서 새로운 TNM 병기분류법에 따른 전 산화단층촬영(computed tomography. CT)의 병기결정의 정확도 및 T병기와 전이 빈도의 관계를 분석하고 바린 T병기가 전이의 빈도에 미치는 영향을 알아보고자 주 연구를 시행하였다. 대상과 방법: 1997년부터 1997년까지 근치적 신절제술을 시행 받은 112명의 환자를 대상으로 수술 전 시행한 CT 병기를 후향적으로 두 명의 방사선과 의사의 협의하에 판정하고 이를 병리소견과 비교하였다. 또한 3년 이상 추적검사가 가능했던 70명의 환자에서 진단 및 추적관찰 기간 중 국소 림프절 전이나 원격전이를 보인 빈도를 이전과 새로운 병기 분류법에 따라 각각의 T병기에서 비교하였다. 결과: 이전 TNM병기분류법에 의한 CT병기 분류는 T1=5(4%). T2=73(65%), T3a=21 (19%) T3b=9(8%). T3c=0(0%), T4=4(4%)였고. 새로운 TNM 병기분류법으로는 T1 = 54(48%) .T2 = 24(21%)였다. 새로운 TNM 병기에 따른 CT 병기결정의 전체적인 정확도는 79% (88/112)이었고 과병기가 17예. 저병기로 판정된 경우는 7예였으며 각 병기에 따른 CT병기결정의 민감도와 특이도는 각각T1: 84%,91%, T2: 71%,95% T3a: 69%,88%; T3b: 78%.98%. T4: 75%,99%로 나타났다 과거 TNM병기에 따른 CT병기결정의 정화도는 77% (86/112)였고 민감도와 특이도는 각각 T1 : 44%,99% ; T2: 82% ,71%이었다. CT에 의한 T 병기에 따른 전이 빈도는 과거 T1 병기와 새로운 T1 병기 및 새로운 T2 병기에서 각각 0% (O/4) .8% (3/39) ,29% (4/14)로 통계적으로 유의한 차이를 보이지 않았고 T3a. T3b의 병기 에서는 67% (6/9) ,75% (6/8)로 새로운 T1 병기에 비해 높은 빈도를 나타났다. 결론: TNM병기분류법에서 CT는 과거 T1 병기에 비해 새로운 T1 병기에서 보다 높은 민감 도를 나타냈다. 신세포암의 T1병기의 기준이 2.5 cm에서 7 cm로상향 조정이 되었으나 과거 T1 병기에 비하여 새로운 T1 병기에서는 전이의 위험성은 의미있게 증가하지 않았다. Purpose: To assess the accuracy of preoperative CT staging of RCC and to compare the relationship between T stage and the incidence of metastasis on the basis of the old (1992) and the new (1997) UICC & AJCC tumor classification system. Materials and Methods: In 112 cases of surgically resected RCC, the stagings of preoperative CT scans were determined retrospectively by two radiologists and were compared with the results of pathologic examinations. In 70 cases which had been followed up over three years after surgery, the incidence of metastasis at initial diagnosis and during the follow-up period was assessed. All cases were reconsidered, and using the old and the new TNM classification, the incidence of metastasis was compared. Results: According to the old TNM classification,5 cases (4%)1 were staged at T1,73(65%) at T2,21(17%) atT3a,9(87,) at T3b,0 at T3c, and 4(47)1 at T4. Using the new TNM classification, we also staged 54 cases (48%1 at T1 and 24(217,1 at T2. Overall, using this new classification, CT correctly staged 77% of patients (88/1121 overstaged 15%(17/112) and understaged 6%(7/1121. CT had a sensitivity of 84% and specificity of 91% in new T1 tumors, 71% and 95% , respectively, in new T2 tumors,69% and 88%) in T3a tumors,78% and 98%) in T3b tumors, and 75% and 99% in T4 tumors. CT had a sensitivity of 44% and a specificity of 99% in old T1 tumors, and 82% and 71%, respectively, in old T2 tumors. The incidence of metastasis in CT-staged (ctrl tumors was 0% (7/41 in old cT1, 8% (3/39) in new cT1, 29% (4/14) in new cT2, 67% (6/9) in cT3a, and 75% (6/8) in cT3b. Conclusion: In the staging of T1 tulnors, CT is more sensitive when the new TNM classification is used. Even though the cut off point between T1 and T2 tumors had been in creased from 2.5 to 7.0 cm,T1 tumors staged according to the new system did not show a significantly higher incidence of metastasis than those staged according to the old.

청장년기 남성에서 기능성 배뇨장애에 대한 요역동학적 분석

성득제,김제종,이정구 大韓泌尿器科學會 1996 Korean Journal of Urology Vol.37 No.4

Concurrent Renal Angiomyolipoma and Renal Cell Carcinoma: Report of Two Cases

강건우,성득제,박범진,김민주,한나연,조성범,이정현 대한영상의학회 2014 대한영상의학회지 Vol.71 No.4

Concurrent renal cell carcinoma (RCC) and angiomyolipoma (AML) is a very rare condition, especially in patients without underlying tuberous sclerosis. We present three patients with concurrent RCC and AML in the ipsilateral kidney. Concurrent RCC is difficult to differentiate radiologically from a non-fatty component of an AML because they share several imaging findings. However, several noticeable ra- diologic features are helpful in the diagnosis of suspected cases. This report of two cases highlights the radiologic features that distinguish RCC from non-fatty com- ponents of AML.

음낭에 발생한 고환외 표피양 낭종의 초음파와 자기공명영상 소견: 증례 보고

강우영,성득제,한나연,박범진,김민주,김제종,김인선,이정현 대한초음파의학회 2012 ULTRASONOGRAPHY Vol.31 No.4

An extratesticular scrotal epidermal cyst is a very rare condition and few cases of extratesticular scrotal epidermal cyst with radiologic findings have been reported. Therefore, we report here on a rare case with ultrasonographic and MRI findings. A 70-year-old male patient was admitted with a palpable mass in the left scrotum. A well-defined heterogeneous hypoechoic mass with scattered echogenic reflectors in the scrotum was identified on ultrasonography. The cystic mass showed high signal intensity on T2-weighted images, low signal intensity on T1-weighted images, and diffusion restriction on diffusion weighted images. 고환 밖에서 발생하는 표피양 낭종은 매우 드문 질환이다. 본 증례에서는 70세 남성에서 발생한 고환외 표피양 낭종의 초음파와 자기공명영상 소견을 보고하고자 한다. 초음파에서 내부에 산재된 반사체 에코를 포함한 저에코의경계가 좋은 종괴가 음낭에서 관찰되었고 자기공명 T2 강조 영상에서 고신호 강도, T1 강조영상에서 저신호 강도,확산 강조 영상에서 확산 제한을 나타낸 낭성 종괴가 보였다.

Gallbladder Wall Thickening and Periportal Tracking on CT in Patients with Acute Pyelonephritis

신재식,성득제,박범진,김민주,조성범,한나연,이남준 대한영상의학회 2012 대한영상의학회지 Vol.67 No.5

Purpose: To assess gallbladder (GB) wall thickening and periportal tracking on CT in patients with acute pyelonephritis (APN) by each kidney involvement. Materials and Methods: A total of 117 patients diagnosed with APN by clinical examination and CT were included in this retrospective study. The patients were divided into three groups based on kidney involvement seen on CT: right APN, left APN, and bilateral APN. Two radiologists reviewed CT images in consensus for the presence of diffuse GB wall thickening and periportal tracking. The prevalence of these two manifestations was compared among the three groups. Results: The prevalence of GB wall thickening in patients with right APN (26.4%) and bilateral APN (19%) was significantly higher than in patients with left APN (0%) (p < 0.016). The prevalence of periportal tracking in patients with right APN (15.1%) and bilateral APN (26%) was higher than in patients with left APN (3%), with a significant difference between patients with bilateral APN and left APN (p < 0.016). Conclusion: GB wall thickening and periportal tracking are predominantly encountered on CT in patients with APN involving the right kidney (right and bilateral APN), and should be considered in differential diagnosis of diseases associated with GB wall thickening and periportal tracking.

항문회음부 결핵성 농양의 자기공명 영상소견: 증례 보고

강우영,성득제,한나연,박범진,김민주,조성범 대한자기공명의과학회 2012 Investigative Magnetic Resonance Imaging Vol.16 No.2

Anoperineal tuberculosis is a rare extrapulmonary form of the disease and may present as abscess. We report a case of anoperineal tuberculous abscess, which showed low signal intensity on T1-weighted images, high signal intensity on T2-weighted images and diffusion restriction on diffusion weighted images.

The Incidence and Anatomy of Accessory Pudendal Arteries as Depicted on Multidetector-Row CT Angiography: Clinical Implications of Preoperative Evaluation for Laparoscopic and Robot-Assisted Radical Prostatectomy

박범진,성득제,김민주,조성범,김윤환,정규병,강석호,천준 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.6

Objective: To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description. Materials and Methods: The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64- channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus. Results: We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs. Conclusion: APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy. Objective: To help preserve accessory pudendal arteries (APAs) and to ensure optimal postoperative sexual function after a laparoscopic or robot-assisted radical prostatectomy, we have evaluated the incidence of APAs as detected on multidetector-row CT (MDCT) angiography and have provided a detailed anatomical description. Materials and Methods: The distribution of APAs was evaluated in 121 consecutive male patients between February 2006 and July 2007 who underwent 64- channel MDCT angiography of the lower extremities. We defined an APA as any artery located within the periprostatic region running parallel to the dorsal vascular complex. We also subclassified APAs into lateral and apical APAs. Two radiologists retrospectively evaluated the origin, course and number of APAs; the final APA subclassification based on MDCT angiography source data was determined by consensus. Results: We identified 44 APAs in 36 of 121 patients (30%). Two distinct varieties of APAs were identified. Thirty-three APAs (75%) coursed near the anterolateral region of the prostatic apex, termed apical APAs. The remaining 11 APAs (25%) coursed along the lateral aspect of the prostate, termed lateral APAs. All APAs originated from the internal obturator artery and iliac artery or a branch of the iliac artery such as the inferior vesical artery. The majority of apical APAs arose from the internal obturator artery (84%). Seven patients (19%) had multiple APAs. Conclusion: APAs are more frequently detected by the use of MDCT angiography than as suggested by previous surgical studies. The identification of APAs on MDCT angiography may provide useful information for the surgical preservation of APAs during a laparoscopic or robot-assisted radical prostatectomy.

Follow-Up of Cryoablated Renal Cell Carcinoma with Residual Contrast Enhancement on CT and MRI

박은경,성득제,박범진,김민주,한나연,조성범,강석호 대한영상의학회 2012 대한영상의학회지 Vol.67 No.5

Purpose: To describe the characteristics of residual contrast enhancement (CE) in cryoablated renal cell carcinoma (RCC) with regard to eventual resolution and the presence of residual tumor on follow-up CT and MRI. Materials and Methods: 22 patients with 24 RCCs underwent laparoscopic renal cryoablation and follow-up CT (n = 19) and MRI (n = 3) for a mean of 28 months. Two radiologists retrospectively assessed the CT and MRI images for the tumor size and characteristics of residual CE in the cryolesions: peripheral rim (< 10% of the maximum cryolesion diameter), focal eccentric (10-25%), and thick internal enhancement (> 25%). Results: Residual CE was seen in 13 cryolesions (54%) at 3-month follow-up. Peripheral rim and focal eccentric enhancement was seen in six (25%) and four (16.7%) cryolesions, persisted for a mean follow-up of 4.5 and 6 months, and disappeared completely at a mean follow-up of 10.5 and 12 months, respectively. Three (12.5%) cryolesions showed persistent thick internal enhancement at 6-month follow-up, and were treated with radiofrequency ablation or chemotherapy. The cryolesions had decreased in size by an average of 20.2% and 39.7% at 6 and 12 months after cryoablation, respectively. Conclusion: Follow-up for ≥ 12 months is needed to assess treatment outcomes in patients with peripheral rim or focal eccentric enhancement of cryoablated RCCs, which may persist until 12 months postoperatively without remnant viable tumor.

Renal Malakoplakia with Wide Extension into the Retroperitoneum: A Case Report

최수연,성득제,한나연,박범진,김민주,심기춘,조성범,이유진 대한영상의학회 2015 대한영상의학회지 Vol.73 No.1

Malakoplakia is a rare chronic inflammatory condition that results from defective phagolysosomal activity. Malakoplakia usually affects the urinary tract, and immunosuppression is a predisposing factor in most patients. A 78-year-old woman undergoing long-term steroid treatment presented with right flank pain. CT demonstrated a large, multilocular cystic mass with focal enhancing solid portion in the right kidney and retroperitoneum. The patient underwent ultrasonography-guided biopsy for enhancing the solid portion, and pathologic examination revealed malakoplakia.